| NPI | 1518255488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: NC 2020-04820) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2020-04820) |
| 207Q00000X Family Medicine (Licence: FL ME132804) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-07-13 |
| Last Update Date | 2022-01-19 |